RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXX	CASE:  PD-2018-00106
BRANCH OF SERVICE:  Air Force 	SEPARATION DATE:  20060424

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects this covered individual (CI) was a Reserve E5, Aerospace Maintenance Craftsman, medically separated for “bilateral lower quadrant abdominal pain” with a disability rating of 10%.  

CI CONTENTION:  In addition to the abdominal pain and fibromyalgia, the CI requested review of additional conditions not identified by the Medical Evaluation Board (MEB) and Physical Evaluation Board (PEB).  The complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The panel’s scope of review is defined in DoDI 6040.44.  It is limited to review of disability ratings assigned to those conditions determined by the PEB to be unfitting for continued military service, and when specifically requested by the CI, those conditions identified by the MEB, but determined by the PEB to be not unfitting or non-compensable.  Any conditions outside the panel’s defined scope of review, and any contention not requested in this application, may remain eligible for future consideration by the Board for Correction of Military Records.  The panel’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections when appropriate.  The panel gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20060313	VARD - 20060829	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Bilateral Lower Quadrant Abdominal Pain 	7615	10%	Total Abdominal Hysterectomy with Bilateral Salpingo-Oophrectomy	7617	50%	20061024	
Fibromyalgia	Cat II	No VA Placement	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  50%	

ANALYSIS SUMMARY:  

Abdominal Pain.  According to the service treatment record (STR) and MEB narrative summary (NARSUM), the CI underwent laparoscopic surgery in March 2004 with aspiration of right ovarian cysts.  The CI underwent left salpingo-oophorectomy (ovary removal) in August 2004 and a right salpingo-oophorectomy with total hysterectomy was performed in November 2004.  At the surgery bowel adhesions were noted and released, underneath which was an area of bowel inflammation.  Pathology showed benign cysts and intrauterine adhesions (scar tissue).  The CI continued to report abdominal pain.  

During the 22 September 2005 MEB NARSUM, 7 months prior to separation, the CI reported her abdominal pain was slowly improving.  Physical examination was performed on 22 August 2004, 20 months prior to separation, and showed the CI ambulated with her hands over her abdomen and had apparent discomfort due to abdominal pain when reclining and sitting up.  The abdomen was soft, mildly tender in the left upper quadrant, with marked tenderness in the right and left lower quadrants without guarding, rebound, organ enlargement or masses. 

At the 24 May 2006 Compensation and Pension (C&P) gynecologic examination, 1 month after separation, the CI reported abdominal pain.  Physical examination noted general abdominal tenderness without rebound.  Bowel sounds were normal and there were no pelvic masses.  At an 11 August 2006 VA outpatient gynecologic examination, 4 months after separation, the CI reported chronic pelvic pain, worsened by movement, without urinary or bowel symptoms.  Physical examination showed diffuse lower abdominal pain, especially over the bladder.  The abdomen was soft, non-distended with diffuse tenderness of the lower quadrants, without masses, rebound or guarding.  The assessment was “chronic pelvic pain most probably due to adhesions secondary to surgery.”  

The panel directed attention to its rating recommendation based on the above evidence.  The PEB rated the abdominal pain due to polycystic ovaries 10%, coded 7615 (disease, injury or adhesions of the ovary), citing “despite numerous treatments including surgery, her pain has not resolved.”  The VA rated the abdominal pain 50%, coded 7617 (complete removal of uterus and both ovaries), based on the STR and C&P examination, citing “complete loss of the uterus and both ovaries following a period of postsurgical convalescence.”  The unfitting condition was persistent abdominal pain and not the loss of the uterus and ovaries.  Therefore rating based on the loss of these organs (as provided by the VA) is not recommended by the panel.  However, panel members agreed a 30% rating under the analogous code of 7699-7615 was supported for symptoms not controlled by continuous treatment.  At both gynecologic surgeries adhesions were noted.  Abdominal adhesions, which are common after abdominal surgeries and most common after surgeries in the lower abdomen and pelvis, were considered the likely cause of the CI’s persistent abdominal pain.  The panel considered other VASRD gynecologic codes, but all were less applicable.  After due deliberation, considering all the evidence and mindful of VASRD §4.3 (reasonable doubt), the panel recommends a disability rating of 30% for the abdominal pain, coded 7699-7615.  

Contended PEB Condition:  Fibromyalgia (FM) and Secondary Pain Disorder.  The panel’s main charge is to assess the fairness of the PEB determinations that the contended conditions were not unfitting.  Neither of the contended conditions were profiled or implicated in the commander’s statement, and did not fail retention standards.  There was no performance-based evidence from the record that either condition significantly interfered with satisfactory duty performance at separation.  After due deliberation, the panel concluded there was insufficient cause to recommend a change in the PEB fitness determinations for the contended conditions, so no additional disability ratings are recommended.  

BOARD FINDINGS:  In the matter of the abdominal pain, the panel recommends a disability rating of 30%, coded 7615 IAW VASRD §4.116.  In the matter of the contended fibromyalgia and pain disorder, the panel recommends no change from the PEB determination as not unfitting.  There are no other conditions within the panel’s scope of review for consideration.  

The panel recommends the CI’s prior determination be modified as follows; and, that the discharge with severance pay be re-characterized to reflect permanent disability retirement, effective the date of medical separation:  

CONDITION	VASRD CODE	PERMANENT RATING	
Bilateral Lower Quadrant Abdominal Pain Due to Polycystic Ovaries	7699-7615	30%	

SAF/MRB
3351 Celmers Lane
JBA NAF Washington, MD 20762-6435

Dear XXXXXXXXXXXX:

		Reference your application submitted under the provisions of DoDI 6040.44 (Section 1554, 10 USC), PDBR Case Number PD-2018-00106.

After careful consideration of your application and treatment records, the Physical Disability Board of Review determined that the rating assigned at the time of final disposition of your disability evaluation system processing was not in accordance with the guidelines of the Veterans Affairs Schedule for Rating Disabilities.  Accordingly, the Board recommended your separation be re-characterized to reflect disability retirement, rather than separation with severance pay

I have carefully reviewed the evidence of record and the recommendation of the Board.    I concur with that finding, accept the recommendation and determined that your records should be corrected accordingly.  The office responsible for making the correction will inform you when your records have been changed.

As a result of the aforementioned correction, you are entitled by law to elect coverage under the Survivor Benefit Plan (SBP).  Upon receipt of this letter, you must contact the Air Force Personnel Center at (210) 565-2273 to make arrangements to obtain an SBP briefing prior to rendering an election.  If a valid election is not received within 90 days from the date of this letter, you will not be enrolled in the SBP program unless at the time of your separation, you were married, in such a case, failure to render an election will result in automatic enrollment by law.